George T Fantry

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Scholarly Contributions

Chapters

• Fantry, G. T. (2024). Drugs Used in the Treatment of Gastrointestinal Disease. In Basic & Clinical Pharmacology.
• Fantry, G. T., Fantry, G. T., Fantry, L. E., James, S. P., & Alpers, D. H. (2009). Chronic Infections of the Small Intestine. In Textbook of Gastroenterology. John Wiley & Sons, Ltd. doi:10.1002/9781444303254.CH49

Journals/Publications

• Amini, R., Laughlin, B. S., Smith, K. W., Siwik, V. P., Adamas-Rappaport, W. J., & Fantry, G. T. (2018). "Flipped classroom" for academic and career advising: an innovative technique for medical student advising. Advances in medical education and practice, 9, 371-376.
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  Career advising for medical students can be challenging for both the student and the adviser. Our objective was to design, implement, and evaluate a "flipped classroom" style advising session.
• Fantry, G. T., Leydorf, S. D., Paranji, N., Park, A. E., Sibia, U. S., Weltz, A. S., & Zahiri, H. R. (2017).

  Primary versus redo paraesophageal hiatal hernia repair: a comparative analysis of operative and quality of life outcomes.

  . Surgical endoscopy, 31(12), 5166-5174. doi:10.1007/s00464-017-5583-0
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  We compared patient outcomes after initial versus redo paraesophageal hernia (PEH) repair at two high-volume GI surgery centers..Retrospective review analyzed one-year outcomes after initial versus redo elective laparoscopic PEH repair, including wound/non-wound-related complications and quality of life benefits as measured by four validated instruments: reflux symptom index, gastroesophageal reflux disease health-related, laryngopharyngeal reflux, and swallowing scales..Three hundred and seventeen patients (271 initial and 46 redo) underwent laparoscopic PEH repair. Groups differed with respect to age (64.6 vs. 60.2 years, p = 0.027), but were comparable in gender (71.2 vs. 67.4% female, p = 0.596), BMI (29.0 vs. 27.6 kg/m2, p = 0.100), and ASA score (2.3 vs. 2.3 p = 0.666). Redo surgery was more complex with longer mean operative times (112.2 vs. 139.1 min, p 
• Fantry, G. T., Park, A. E., Sibia, U. S., Weltz, A. S., Wu, N., & Zahiri, H. R. (2017).

  Patients are well served by Collis gastroplasty when indicated.

  . Surgery, 162(3), 568-576. doi:10.1016/j.surg.2017.04.005
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  Debate persists over the impact of Collis gastroplasty (CG) on outcomes after anti reflux surgery. This study analyzed operative and quality of life (QOL) outcomes from one of the largest series of laparoscopic anti reflux surgery (LARS) with CG reported to date..A retrospective review was conducted to compare outcomes between patients undergoing LARS with CG versus without CG at two large centers with expertise in foregut surgery from October 2004-December 2011 and July 2012-September 2016. Demographic, perioperative, and QOL data were reviewed. Four validated surveys were used for QOL outcomes: reflux symptom index (RSI), gastroesophageal reflux disease health-related QOL (GERD-HRQL), laryngopharyngeal reflux health-related QOL (LPR-HRQL), and swallowing QOL (SWAL-QL)..480 patients consisted of 149 Collis vs 331 non-Collis with mean age of 66.3 vs 58.9 years (P ≤ .001), BMI of 28.6 vs 29.7 (P = .040) and ASA score of 2.4 vs 2.2 (P = .005) were included. Collis patients underwent longer duration operations (133.2 mins vs 94.2; P ≤ .001) with greater duration of hospital stay (3.1 vs 1.8; P ≤ .001). Thirty-day readmission and reoperation rates were equivalent between the two groups. Wound and non-wound related complications were also comparable. After mean 12 month follow up, QOL assessment revealed significant improvements for all patients post-surgery with comparable results between Collis and non-Collis patients. Furthermore, CG did not contribute to post-operative dysphagia, reflux, or a significant leak rate..Patients who require a CG to address a true short esophagus during LARS have comparable operative and QOL benefits as non-Collis patients without added morbidity or mortality.
• Zahiri, H. R., Weltz, A. S., Park, A., Mohiuddin, K., Leydorf, S. D., & Fantry, G. T. (2017). Primary vs. Redo Paraesophageal Hiatal Hernia Repair: A Comparative Analysis of Operative and Quality of Life Outcomes. Surg Endosc, 150(4), S1181. doi:10.1016/s0016-5085(16)33987-7
• Beale, S., Fantry, G. T., Jarrell, B., Mcshane, M., & Nirenburg, S. (2012).

  Inconsistency as a diagnostic tool in a society of intelligent agents.

  . Artificial intelligence in medicine, 55(3), 137-48. doi:10.1016/j.artmed.2012.04.005
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  To use the detection of clinically relevant inconsistencies to support the reasoning capabilities of intelligent agents acting as physicians and tutors in the realm of clinical medicine..We are developing a cognitive architecture, OntoAgent, that supports the creation and deployment of intelligent agents capable of simulating human-like abilities. The agents, which have a simulated mind and, if applicable, a simulated body, are intended to operate as members of multi-agent teams featuring both artificial and human agents. The agent architecture and its underlying knowledge resources and processors are being developed in a sufficiently generic way to support a variety of applications..We show how several types of inconsistency can be detected and leveraged by intelligent agents in the setting of clinical medicine. The types of inconsistencies discussed include: test results not supporting the doctor's hypothesis; the results of a treatment trial not supporting a clinical diagnosis; and information reported by the patient not being consistent with observations. We show the opportunities afforded by detecting each inconsistency, such as rethinking a hypothesis, reevaluating evidence, and motivating or teaching a patient..Inconsistency is not always the absence of the goal of consistency; rather, it can be a valuable trigger for further exploration in the realm of clinical medicine. The OntoAgent cognitive architecture, along with its extensive suite of knowledge resources an processors, is sufficient to support sophisticated agent functioning such as detecting clinically relevant inconsistencies and using them to benefit patient-centered medical training and practice.
• Beale, S., Fantry, G. T., Jarrell, B., Mcshane, M., & Nirenburg, S. (2009).

  Integrating cognitive simulation into the Maryland virtual patient.

  . Studies in health technology and informatics, 142, 224-9.
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  This paper briefly describes four cognitively-related aspects of modeling a virtual patient: interoception, decision-making, natural language processing and learning. These phenomena are treated within the Maryland Virtual Patient simulation and training environment.
• Beale, S., Fantry, G. T., Jarrell, B., Mcshane, M., & Nirenburg, S. (2009).

  Maryland virtual patient: a knowledge-based, language-enabled simulation and training system

  . Bio-Algorithms and Med-Systems, 5(9), 57-63.
• Beale, S., Fantry, G. T., Jarrell, B., Johnson, B., Mcshane, M., & Nirenburg, S. (2008).

  Revealing the conceptual substrate of biomedical cognitive models to the wider community.

  . Studies in health technology and informatics, 132, 281-6.
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  The patient authoring interface for each disease in the Maryland Virtual Patient simulation environment reveals the conceptual substrate of the disease model. Revealing the disease model to the community both explains how the interactive simulations work and invites collaboration from the wider community.
• Castellanos, P. F., Fantry, G. T., Godinez, C., Kavic, S. M., Park, A. E., Roth, J. S., & Seagull, F. J. (2008).

  M1525 Acid Reflux to the Proximal Esophagus Predicts Postoperative Success in Patients with Laryngopharyngeal Reflux Disease

  . Gastroenterology, 134(4), A-866. doi:10.1016/s0016-5085(08)64057-3
• Fantry, G. T., George, I. M., Godinez, C., Kavic, S. M., Lee, T. H., & Park, A. E. (2008).

  T2097 A Novel System for Classifying Paraesophageal Hernias

  . Gastroenterology, 134(4), A-896. doi:10.1016/s0016-5085(08)64209-2
• Beale, S., Fantry, G. T., Jarrell, B., Mallott, D., Mcshane, M., Nirenburg, S., & Raczek, J. (2007).

  An interactive, cognitive simulation of gastroesophageal reflux disease.

  . Studies in health technology and informatics, 125, 194-9.
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  The Maryland Virtual Patient (MVP) Project seeks to create realistically functioning virtual humans endowed with automatic physiological and cognitive function that can be used in the training of medical personnel. Physiologically, the state of an MVP changes in response to internal pathophysiological stimuli and external stimuli, the latter initiated by either by the patient or the trainee. Cognitively, the MVP can communicate with trainees about current symptoms, lifestyle, history, adherence to prescribed treatments, etc. We will demonstrate simulation in the MVP environment using the example of patients suffering from gastroesophageal reflux disease (GERD).
• Fantry, G. T., Sajadi, M. M., Mackowiak, P. A., Fantry, L. E., & Fantry, G. T. (2004). A Czech researcher and Pneumocystis.. Clinical Infectious Diseases, 39(2), 218, 270-1. doi:10.1086/422004
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  In 1909, two years after the birth of Otto Jirovec (figure 1) in Bohemia, Carlos Chagas described an organism in the lungs of infected guinea pigs that he named Schizotrypanum cruzi [1, 2]. In 1912, Antonio Carini noted these same organisms in the lungs of rats. Both researchers were convinced that what they had observed was a type of trypanosome. However, later that year, at the Pasteur Institute, the husband-and-wife team of Delanoe and Delanoe [3] demonstrated that the cysts observed in the lungs of Carini's rats were unrelated to trypanosomes and named the organism Pneumocystis carinii. In the 1930s and 1940s, an epidemic form of pneumonia was recognized in European infants who were born prematurely [1]. This pneumonia, called "interstitial plasma cell pneumonia," was associated with death by the age of 6 months [4]. It was not until 1951 that Otto Jirovec, along with Joseph Vanek, demonstrated that the etiologic agent of interstitial plasma cell pneumonia was Pneumocystis. Otto Jirovec started out as a zoologist studying microsporidia and later contributed to the understanding of Trichomonas vaginalis, Toxoplasma, and Leptospira [5]. However, he is most famous for his work on Pneumocystis, both for his initial description of the species that infects humans and later for his studies of its development and epidemiology. In 1976, four years after Otto Jirovec's death, Jacob Frenkel proposed to use the name of Pneumocystis carinii for the species that infects rats and to use Pneumocystis jerovici for the species that infects humans, on the basis of the knowledge that interspecies infection was not experimentally possible [2]. In the late 1980s, RNA analysis demonstrated that Pneumocystis was a fungus, not a protozoa [6, 7]. Ironically, it was not until 1999, after this change in taxonomy, that the species of Pneumocystis that infects humans was renamed Pneumocystis jiroveci after the great Czech parasitologist [2].
• Cotto-cumba, C., Darwin, P. E., Drachenberg, C. B., Fantry, G. T., & Lustberg, A. M. (2002).

  Hyperbaric oxygen treatment for intractable diarrhea caused by pneumatosis coli

  . Gastrointestinal Endoscopy, 56(6), 935-937. doi:10.1016/s0016-5107(02)70381-7
• Abe, A., Donnenberg, M. S., Fantry, G. T., Finlay, B. B., James, S. P., Levine, M. M., Losonsky, G., Mcnamara, B. P., Nataro, J. P., Sztein, M. B., & Tacket, C. O. (2000).

  Role of EspB in experimental human enteropathogenic Escherichia coli infection.

  . Infection and immunity, 68(6), 3689-95. doi:10.1128/iai.68.6.3689-3695.2000
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  Enteropathogenic Escherichia coli (EPEC), a leading cause of diarrhea among infants in developing countries, induces dramatic alterations in host cell architecture that depend on a type III secretion system. EspB, one of the proteins secreted and translocated to the host cytoplasm via this system, is required for numerous alterations in host cell structure and function. To determine the role of EspB in virulence, we conducted a randomized, double-blind trial comparing the ability of wild-type EPEC and an isogenic DeltaespB mutant strain to cause diarrhea in adult volunteers. Diarrhea developed in 9 of 10 volunteers who ingested the wild-type strain but in only 1 of 10 volunteers who ingested the DeltaespB mutant strain. Marked destruction of the microvillous brush border adjacent to adherent organisms was observed in a jejunal biopsy from a volunteer who ingested the wild-type strain but not from two volunteers who ingested the DeltaespB mutant strain. Humoral and cell-mediated immune responses to EPEC antigens were stronger among recipients of the wild-type strain. In addition, four of the volunteers who ingested the wild-type strain had lymphoproliferative responses to EspB. These results demonstrate that EspB is a critical virulence determinant of EPEC infections and suggest that EspB contributes to an immune response.
• Drachenberg, C. B., Fantry, G. T., Heller, T., & Orens, J. B. (2000).

  Primary posttransplant lymphoproliferative disorder of the gallbladder in a lung transplant patient presenting with acute cholecystitis.

  . Transplantation, 69(4), 668-70. doi:10.1097/00007890-200002270-00033
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  Acute cholecystitis in an immunocompromised host is potentially devastating. Posttransplant lymphoproliferative disorder (PTLD) is a well described complication of immunosuppressive therapy used after solid organ transplantation; however, isolated involvement of the gallbladder has not been described..Case report format is used..We report a case of PTLD isolated to the gallbladder, as well as histological evidence of acute cholecystitis, in a patient who presented with signs and symptoms of acute cholecystitis 1 year after single lung transplant..PTLD can occur in the setting of acute cholecystitis and may be missed if careful pathological examination is not undertaken.
• Drachenberg, C. B., Fantry, G. T., Fu, S., James, S. P., Meltzer, S. J., Ramanujam, K. S., Wilson, K. T., & Wong, A. (1999).

  Increased expression and cellular localization of inducible nitric oxide synthase and cyclooxygenase 2 in Helicobacter pylori gastritis.

  . Gastroenterology, 116(6), 1319-29. doi:10.1016/s0016-5085(99)70496-8
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  Inducible nitric oxide synthase (iNOS) and cyclooxygenase (COX)-2 are important regulators of mucosal inflammation and epithelial cell growth. To determine the role of iNOS and COX-2 in Helicobacter pylori-induced tissue injury, we compared their gene expression in H. pylori-induced gastritis with that in normal gastric mucosa and in non-H. pylori gastritis..In 43 patients, we assessed H. pylori infection status, histopathology, messenger RNA (mRNA) and protein expression, and cellular localization of iNOS and COX-2..By reverse-transcription polymerase chain reaction (RT-PCR), antral iNOS and COX-2 mRNA expression was absent to low in normal mucosa (n = 10), significantly increased in H. pylori-negative gastritis (n = 13), and even more markedly increased in H. pylori-positive gastritis (n = 20). Increased iNOS and COX-2 levels were confirmed by Northern and Western blot analysis and were both greater in the gastric antrum than in the gastric body of infected patients. Immunohistochemistry also showed increased expression of both genes in H. pylori gastritis: iNOS protein was detected in epithelium, endothelium, and lamina propria inflammatory cells, and COX-2 protein localized to mononuclear and fibroblast cells in the lamina propria..iNOS and COX-2 are induced in H. pylori-positive gastritis and thus may modulate the inflammation and alterations in epithelial cell growth that occur in this disease. Higher levels of iNOS and COX-2 in H. pylori-positive vs. -negative gastritis and in gastric antrum, where bacterial density is greatest, suggest that expression of these genes is a direct response to H. pylori infection.
• Fantry, G. T., & Wilson, K. T. (1999).

  Pathogenesis of Helicobacter pylori infection.

  . Current opinion in gastroenterology, 15(1), 66-71. doi:10.1097/00001574-199901000-00012
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  Intensive investigation into the interactions of Helicobacter pylori with the human host during the period of this review has led to several important developments in our understanding of H. pylori pathogenesis. There is direct evidence to support a central role for bacterial adhesion to host gastric epithelial Lewis antigens. Adherence can result in activation of host signaling cascades, including tyrosine phosphorylation events. H. pylori induces an immune response that is skewed toward a T-helper cell (Th) 1 phenotype, and an insufficient Th2 response is associated with the inability of the host to eradicate the organism. An area of active investigation has been the induction of epithelial apoptosis, both in direct response to H. pylori and by T-cell mediated pathways. Although the consensus is that the cagA gene product is not involved in pathogenesis, the presence of the cag pathogenicity island is associated with increased gastric inflammation and decreased epithelial repair. Interestingly, infection with cagA+H. pylori appears to result in decreased prevalence of both gastroesophageal reflux disease and adenocarcinoma of the esophagus and cardia.
• Fantry, G. T., Lim, Y., Losonsky, G. A., & Reymann, M. (1999).

  Validation of a gastrointestinal explant system for measurement of mucosal antibody production.

  . Clinical and Vaccine Immunology, 6(6), 803-807. doi:10.1128/cdli.6.6.803-807.1999
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  A gastrointestinal explant culture system was developed and compared to the mononuclear cell extraction and enzyme-linked immunospot assay method for measurement of immunoglobulin A (IgA) and IgG antibody-secreting cells (ASCs) in gastric antral and duodenal biopsies of non- Helicobacter pylori -infected volunteers. IgA and IgG were detected in explant supernatants during 6 to 7 days of culture in all subjects. IgA containing secretory component was also detected throughout the culture period, although peak production occurred only in the first 3 days. During 7 days of culture, the cumulative geometric mean IgA levels produced were 2.2 and 8.02 μg/ml/10 mg of antral and duodenal biopsy tissues, respectively, while the cumulative geometric mean IgG levels were 1.54 and 2.92 μg/ml/10 mg of antral and duodenal biopsy tissues, respectively. Cycloheximide treatment resulted in a >90% reduction in both immunoglobulin classes after 6 days of treatment compared to levels in untreated controls. The detection of IgA and IgG ASCs extracted from biopsies on days 1 and 6 of culture confirmed that the antibody detected was derived from mucosal lamina propria. The IgA and IgG ASC responses were positively correlated with antibody concentrations detected in culture supernatants ( r = 0.87 and 0.85, respectively). These results validate the potential usefulness of our gastrointestinal explant system for the evaluation of mucosal effector B-cell function.
• Rosenstein, A. H., James, S. P., & Fantry, G. T. (1999). Confounding factors in the detection of Helicobacter pylori infection in patients with upper gastrointestinal bleeding.. The American journal of gastroenterology, 94(5), 1421-2. doi:10.1111/j.1572-0241.1999.01421.x
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  Confounding Factors in the Detection of Helicobacter pylori Infection in Patients With Upper Gastrointestinal Bleeding
• Daly, B., Drachenberg, C. B., Fantry, G. T., Flowers, J., Kushner, H., & Zangara, J. (1998).

  Iron deficiency anemia due to a Brunner's gland hamartoma.

  . Journal of clinical gastroenterology, 27(4), 353-6. doi:10.1097/00004836-199812000-00017
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  Brunner's gland hamartomas are rare benign duodenal tumors often discovered incidentally during endoscopy or on an upper gastrointestinal series. These tumors arise mainly in the duodenal bulb and can present with gastrointestinal bleeding or symptoms of intestinal obstruction. When symptomatic, surgical or endoscopic removal can be safely performed and the prognosis is very good. We describe a 63-year-old man presenting with iron deficiency anemia due to a large Brunner's gland hamartoma and review the endoscopic, radiologic, surgical, and pathologic findings.
• Fantry, G. T., Varanasi, R. V., & Wilson, K. T. (1998).

  Decreased prevalence of Helicobacter pylori infection in gastroesophageal reflux disease.

  . Helicobacter, 3(3), 188-94. doi:10.1046/j.1523-5378.1998.08001.x
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  An increased incidence of reflux esophagitis has been reported after eradication of H. pylori in patients with duodenal ulcer. To determine if H. pylori is associated with lower rates of esophagitis, we studied the prevalence of H. pylori infection in patients with and without reflux esophagitis and a subgroup of patients with concomitant peptic ulcer disease..Patients who underwent esophagogastroduodenoscopy and had diagnostic testing for H. pylori over a 30-month period were studied. H. pylori infection was determined by rapid urease testing, gastric histopathology, or serology. Reflux esophagitis was determined by endoscopic and/or histologic criteria..Of 514 patients, 39.5% had H. pylori infection and 22.2% had reflux esophagitis. The prevalence of H. pylori infection in patients with reflux esophagitis was 30.7%, compared with 42.0% in patients without esophagitis (p = 0.039). The odds ratio for esophagitis risk with H. pylori infection was 0.61 (95% CI, 0.39-0.95). Neither patient age nor gender affected H. pylori prevalence. In patients with duodenal ulcer, H. pylori was present in 36.4% of patients with esophagitis and in 69.2% of patients without esophagitis (p = 0.018). The odds ratio for esophagitis with H. pylori infection in these patients was 0.25 (95% CI, 0.09-0.73)..Our study demonstrates that H. pylori infection is significantly less prevalent in patients with reflux esophagitis and may protect against its development. In duodenal ulcer patients, this effect was more dramatic. Further study is required to confirm these findings and elucidate mechanisms underlying possible beneficial effects of H. pylori.
• Fantry, G. T., Varanasi, R. V., & Wilson, K. T. (1998).

  Protective role of Helicobacter pylori infection in gastroesophageal reflux disease

  . Gastroenterology, 114, A322-A323. doi:10.1016/s0016-5085(98)81308-5
• Darwin, P. E., Fantry, G. T., James, S. P., Rosenstein, A. H., & Zheng, Q. X. (1996).

  Mixed infection with cagA-positive and cagA-negative strains of Helicobacter pylori.

  . Helicobacter, 1(2), 98-106. doi:10.1111/j.1523-5378.1996.tb00018.x
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  Helicobacter pylori infection has been implicated strongly in the pathogenesis of gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric lymphoma, but the reasons for these widely different clinical outcomes are unknown. The aim of this study was to determine whether these differences could be due in part to mixed infection in the same individual, with bacteria having differences in pathogenic factors associated with ulcers..The cagA gene of H. pylori was used to test for mixed infection because it is present in only some strains, and its presence has been associated with ulcers. Polymerase chain reaction (PCR) assays for the cagA gene were applied to H. pylori culture isolates and endoscopic gastric aspirates. Individual bacterial clones were tested for genetic similarity by random primer amplification and restriction endonuclease digestion of urease gene PCR products..The majority of H. pylori-positive patients had strongly cagA-positive culture isolates and endoscopic samples (62.5% and 69.6%, respectively). However, many of these patients had evidence of mixed infection with cagA negative and cagA positive strains in cultures isolates and endoscopic samples (25% and 17.4%, respectively). Mixed infection was found to be due to genetically unrelated strains in two patients in whom genetic analysis was performed..Mixed infection with differences in substrain pathogenic factors might occur in H. pylori infection and might contribute to differences in clinical outcome.
• Darwin, P. E., Fantry, G. T., James, S. P., Sztein, M. B., & Zheng, Q. X. (1996).

  Immune evasion by Helicobacter pylori: gastric spiral bacteria lack surface immunoglobulin deposition and reactivity with homologous antibodies.

  . Helicobacter, 1(1), 20-7. doi:10.1111/j.1523-5378.1996.tb00004.x
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  Helicobacter pylori infection persists in the presence of potent serum and gastric mucosal antibody responses against bacterial antigens. The aim of this article is to report on a study determine whether there is antibody deposition on H. pylori in vivo in the stomach of infected patients and whether gastric and cultured forms of H. pylori differ in their antibody reactivity..Serum, gastric biopsies, and antral brushings were obtained from 10 patients having endoscopy. H. pylori was cultured from gastric biopsies. Bacterial samples were stained directly for immunoglobulin deposition and indirectly using rabbit antiurease serum or patient serum. Samples were examined by immunofluorescence microscopy and flow cytometry..Although spiral bacteria could be identified easily by acridine orange staining and antiurease staining of gastric brushings from H. pylori infected patients, gastric bacteria did not have detectable IgG or IgA present, and only one of five samples could be stained for IgG and IgA indirectly using patient serum. In contrast, cultured bacteria could be stained readily with homologous serum for IgG and IgA in the majority of cases. Low pH inhibited immunoglobulin reactivity with cultured H. pylori..Gastric H. pylori may evade humoral defense owing to poor deposition of immunoglobulin in the gastric environment or failure to express surface antigens that are present on cultured forms of H. pylori.
• Fantry, G. T., & James, S. P. (1995).

  Whipple's disease.

  . Digestive diseases (Basel, Switzerland), 13(2), 108-18. doi:10.1159/000171492
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  Whipple's disease is a chronic systemic infectious disease caused by Tropheryma whippelii that typically involves the small intestine and causes malabsorption. Extraintestinal manifestations such as arthritis and fever are common and often exist prior to the onset of gastrointestinal symptoms. Involvement of the central nervous system can occur and lead to permanent sequelae. Weight loss, hyperpigmentation, and lymphadenopathy are frequent findings. The definitive diagnosis is made by biopsy of the small intestine mucosa which reveals infiltration of the lamina propria of the small intestine with periodic acid-Schiff positive macrophages. Treatment with trimethoprim combined with sulfamethoxazole for 1 year usually results in clinical remission and an excellent prognosis. Recent advances using molecular techniques to identify the uncultured bacillus of Whipple's disease should lead to a better understanding of the pathophysiology and allow for the development of a sensitive noninvasive diagnostic test.
• Fantry, G. T., James, S. P., & Zheng, Q. X. (1995).

  Conventional cleaning and disinfection techniques eliminate the risk of endoscopic transmission of Helicobacter pylori.

  . The American journal of gastroenterology, 90(2), 227-32.
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  To determine whether endoscopes serve as a reservoir for Helicobacter pylori and whether two commonly used cleaning and disinfection methods eliminate the risk of H. pylori transmission..A prospective study was carried out in 107 patients who were undergoing upper gastrointestinal endoscopy for routine clinical indications. H. pylori DNA was assayed by polymerase chain reaction (PCR) of endoscope washes before and after procedure, in gastric aspirates and in endoscope washes after cleaning and disinfection of endoscopes. Gastric biopsies were assayed by rapid urease test (CLOtest, Tri-Med Specialties Inc., Lenexa, KS) of two antral biopsies..Forty-one of 107 (38%) patients were H. pylori-positive by PCR. Endoscopes were contaminated after 25 of 41 (61%) H. pylori-positive procedures. However, 107 of 107 pre-endoscopy and postcleaning aspirates were negative, indicating that decontamination was 100% effective. The urease test was positive in 25 of 41 H. pylori-positive patients, a sensitivity of 61%. PCR was positive in 41 of 41 H. pylori-positive patients, a sensitivity of 100%. In 5 of 16 PCR-positive/urease-negative patients, the identification of H. pylori was clinically relevant..Endoscopes are frequently contaminated with H. pylori after endoscopy in H. pylori-infected patients, but conventional cleaning and disinfection techniques are highly effective in eliminating H. pylori. When appropriate negative control samples are obtained from the endoscope, PCR of endoscopic gastric aspirates appears to be a sensitive test that can detect clinically relevant H. pylori infection that is missed when only a rapid urease test is used.
• James, S. P., & Fantry, G. T. (1994). Cell-mediated immunity and mucosal immunity. Current Opinion in Gastroenterology, 10(4), 365-373. doi:10.1097/00001574-199407000-00003
• James, S. P., & Fantry, G. T. (1993). Cellular and molecular immunology and biochemistry of inflammatory bowel disease. Current Opinion in Gastroenterology, 9(4), 544-551. doi:10.1097/00001574-199307000-00004
• Chow, C. C., Fantry, G. T., Kotlyarov, E. V., & Pichney, L. S. (1992).

  Ga-67 citrate in diagnosing tracheoesophageal fistula in a patient with AIDS. Case report.

  . Clinical nuclear medicine, 17(2), 103-5. doi:10.1097/00003072-199202000-00007
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  Increased radiopharmaceutical uptake in the mediastinum and/or hilum on Ga-67 citrate scan in patients with AIDS has been attributed, to date, mostly to infectious etiologies. Because other complications are being reported in these patients, awareness of their presentation in diagnostic imaging is important. Tracheoesophageal fistula can also be accompanied by a focal area of increased uptake in the mediastinum. In this patient, a Ga-67 citrate scan was the first modality of diagnostic imaging to raise suspicion of such a diagnosis.
• Fantry, G. T., Graham, S. M., & Pichney, L. S. (1992).

  Gastrocolic and duodenocolic fistulas in Crohn's disease.

  . Journal of clinical gastroenterology, 15(3), 205-11. doi:10.1097/00004836-199210000-00006
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  Crohn's disease is a rare cause of gastrocolic and duodenocolic fistulas. Only 83 examples (27 gastric, 52 duodenal, four both) have been described. Weight loss, abdominal pain, and diarrhea are common features but fail to distinguish a fistula from active inflammatory bowel disease. Fecal vomiting is pathognomic but is present in one third of gastrocolic and only 2% of duodenocolic fistulas. Diagnosis is most readily made by contrast radiography, with barium enema being more sensitive than barium meal. Although several gastrocolic fistulas have been successfully treated with long-term 6-mercaptopurine, surgery is the mainstay of therapy. An isolated duodenocolic fistula should not be regarded as the primary indication for operation because most are asymptomatic. Ileocolonic resection with simple gastric or duodenal repair is safe and effective in most cases. An ileocolonic anastomosis should be positioned away from the stomach or duodenum or protected with omentum to prevent recurrent fistulization. A number of fistulas appear to have arisen from gastric or duodenal Crohn's, but the vast majority originate from diseased colon.